<!DOCTYPE html>
<html>
<head>
	<title>{dede:global.cfg_webname/}</title>
	<meta name="viewport" charset="utf-8" content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no">
	<link rel="stylesheet" type="text/css" href="/templets/phonempudle/css/public.css">
	<link rel="stylesheet" type="text/css" href="/templets/phonempudle/css/online.css">
	<script type="text/javascript" src="/templets/phonempudle/js/jquery1.42.min.js"></script>
	<script type="text/javascript" src="/templets/phonempudle/js/TouchSlide.1.1.source.js"></script>
	<script type="text/javascript" src="/templets/phonempudle/js/online.js"></script>
</head>
<body>
{dede:include filename="pages/top_menu.htm"/}
{dede:include filename="pages/top_ul.htm"/}
<div class="online_div">
	<div class="online_logo">
		<img src="http://oor4c3c8g.bkt.clouddn.com/yuyue_shouji_01.png">
	</div>
	<div class="online_title">
		<img src="http://oor4c3c8g.bkt.clouddn.com/yuyue_shouji_02.png">
		<div class="online_word">
			免费预约·无需排队·优先就诊
		</div>
	</div>
	<div class="form_div">
		<form id="myform" method="post" action="http://mail.jszjrzk.com/youdao/phone" accept-charset="utf-8">
			<div class="rol">
				<div class="label">姓名：</div>
				<input class="long" id="name" type="text" name="name" placeholder="请输入您的姓名">
			</div>
			<div class="rol">
				<div class="label">联系电话：</div>
				<input class="long" id="phone" type="text" name="phone" placeholder="请输入您的联系电话">
			</div>
			<div class="rol">
				<div class="label">您的病种：</div>
				<select id="disease" name="disease" class="disease">
					<option value="肥胖症">肥胖症</option>
					<option value="糖尿病">糖尿病</option>
				</select>
			</div>
			<div class="rol">
				<div class="label">预约时间：</div>
				<input class="date" id="date" type="date" name="date" placeholder="请输入您的姓名">
			</div>
			<div class="rol">
				<div class="label">身高：</div>
				<input class="duan" id="height" type="text" name="height" placeholder="请输入您的身高">
				<div class="unit">CM</div>
			</div>
			<div class="rol">
				<div class="label">体重：</div>
				<input class="duan" id="weight" type="text" name="weight" placeholder="请输入您的体重">
				<div class="unit">KG</div>
			</div>
			<div class="bmi_div">
				您的BMI为&nbsp;:&nbsp;<span id="bmi_show">0.0</span>
				<input type="hidden" id="bmi" name="bmi">
			</div>
			<div class="btn_div">
				<input class="reset_btn" type="reset" name="" value="">
				<input class="sub_btn" type="button" name="" value="">
			</div>
		</form>
	</div>
</div>
{dede:include filename="pages/footer.htm"/}
</body>
</html>